Coblation 03.09(CN)课件.ppt

* Coblation * 临床应用和适应症 注意 – 错误使用! Lu et al. Arthroscopy 2001 - 设为热凝档位 - 电极紧贴组织表面 - 刀头连续工作超过30 秒 - 在组织表面移动过慢 * Coblation * 临床应用和适应症 正确使用 刀头 主机档位设定 手术操作 刀头启动 ? ? ? ? * Coblation * 结论 射频技术优于机械切割。 双极等离子切割比其他方式更加精确和安全。 低温等离子技术的优势: 快速，高效，精确 对周围正常组织损伤最小 非机械切割，低温消融 40o - 70o C * Coblation * 结论 专为关节软骨损伤而设计- Outerbridge Grades 2 3 Paragon T2 对正常的关节软骨损伤最小，留下光滑平整的关节软骨边缘。 PARAGON T2 * Coblation * 忘了什么? 感谢骨科中心的同事们 * The mechanism of laser interaction with tissue depends on the wavelength, pulse duration, and duty cycle of the applied energy. Carbon dioxide lasers, like standard electrosurgical tools, operate by the generation of extreme heat to cause cellular pyrolysis. Ultraviolet lasers, also known as excimer lasers, achieve what is now commonly referred to as “cold ablation.” Experimentalresearch has demonstrated that the photons emitted atthe wavelengths at which these lasers operate have sufficient energy to effect photodissociation of human tissue. Through this mechanism large organic molecules as well as water can be disintegrated. However, to prevent excessive secondary heating within the plume of ablation products, excimer lasers generally must be operated in a pulsed mode, wherein very brief pulses are separated by periods of 50 to 100 milliseconds to allow the ablation plume to dissipate. If the period between pulses becomes too short, excessive heating within the plume causes an increase in collateral tissue damage as well as a decrease in the rate of ablation. Coblation 低温等离子技术在肩和膝关节镜手术中的应用 Dr. H. – G. Fieseler MD Orthopedic and Trauma Surgery Center for Shoulder -, Knee -, Arthroscopic Surgery and Sports Medicine 34346 Hann. Münden - Germany www.zoc-hann-muenden.de * Coblation * 主要内容 什么是低温等离子技术? 低温等离子消融与机械切割的区别 低温等离子技术的临床应用经验和建议 * Coblation * 什么是低温等离子技术 ?与其他消融系统的区别？ 传统的单极电外科刀头会在与工作电极接触的组织表面在很短的时间内产生极高的温度。高温使组织汽化，从而产生切割效果，但伴随着高温，周围组织也会受到相当大的热损伤。 * Coblation * 什么是低温等离子技术 ?与其他消融系统的区别？ 激光消融的机制依赖于激光源的波长，脉冲宽度和负载循环。 二氧化碳激光作为标准的电外科工具，通过高温使组织细胞分解。 紫外线激光作为准分